Provider Demographics
NPI:1396333498
Name:JARMIE HARRIS, LAUREN CAMILLE (PHD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:CAMILLE
Last Name:JARMIE HARRIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:L.
Other - Middle Name:CAMILLE
Other - Last Name:JARMIE HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2601 N STOCKTON HILL RD STE E1
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4167
Mailing Address - Country:US
Mailing Address - Phone:928-514-8614
Mailing Address - Fax:
Practice Address - Street 1:2601 N STOCKTON HILL RD STE E1
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4167
Practice Address - Country:US
Practice Address - Phone:928-514-8614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY005306103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent